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Nephrol Dial Transplant (2002) 17: 519
© 2002 European Renal Association-European Dialysis and Transplant Association

Letters and Replies

Lupus nephritis in the new millennium

E. Nigel Wardle

Grimsby, UK

Sir,

The lack of evidence base for new treatments for lupus nephritis [1] stems from a lack of attention to procedures established in the old millennium. We have not crossed a dividing line. Reliance on formal trials, as the only evidence, is sure to be hampered by the difficulty in organizing trials when patients must be pooled from several centres.

By frequent monitoring of GN patients using laboratory measurement of indices of activity, one can know within 2–3 months whether a new treatment for proliferative lupus GN will be successful. Various measureable parameters are available in SLE, such as anti-ds DNA titres, serum thrombomodulin, serum IFN{delta}, urine neopterin, urine thromboxane and several urine cytokines. What is lacking is the organization and a standard reference library.

There has been a lack of appreciation too of the value of the radio-fibrinogen catabolism study for the monitoring of activity of proliferative nephritis [2,3]. There was one study devoted to SLE [4]. However, I must point out that, as was taught by the originator of the test AS McFarlane of the Biophysics Division, Mill Hill, UK, serum half-life of injected radio-fibrinogen is not totally reliable and one must use 24 h urine collections to calculate the fractional catabolic rate of labelled fibrinogen [5,6].

References

  1. Adu D. The evidence base for the treatment of lupus nephritis in the new millennium. Nephrol Dial Transpl2001; 16: 1536–1538[Free Full Text]
  2. Wardle EN. Radio-fibrinogen catabolism in patients with renal disease. Q J Med1973; 42: 205–211[Abstract/Free Full Text]
  3. Wardle EN. Anticoagulation in renal disease: 20 years in and what is the outcome? Nephron1986; 44: 81–84[Medline]
  4. Sergent JS, Sherman RL, Al-Mondhiry H. Fibrinogen actabolism in SLE. Arthritis Rheumatism1976; 19: 195–199[Medline]
  5. McFarlane AS. In vivo behaviour of 131-iodine fibrinogen. J Clin Invest1963; 42: 346–361
  6. Regoeczi E. Iodine labelled fibrinogen: a review. Br J Haematol1971; 20: 649–663[Medline]
 

Reply

Dwomoa Adu

Department of Nephrology Queen Elizabeth Hospital Birmingham, UK

Sir,

My review looked at the evidence base for the treatment of lupus nephritis and found it sadly lacking. Unlike Dr Wardle, I think that the best way forward for improving the treatment for lupus nephritis is through carrying out appropriately powered and sized randomized controlled trials of therapy. To recruit adequate numbers of patients these will need to be multi-centre studies. The laboratory investigations suggested by Dr Wardle might have a role in pilot studies of the efficacy of new therapies for lupus nephritis but that could be tested.

Notes

Email: dwoms{at}aol.com Back


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